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胃肠道间质瘤组织中内皮细胞特异性分子-1的表达及其与胶原酶及组织抑制因子的关系
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摘要
背景:胃肠道间质瘤(gastrointestinal stromal tumor, GIST)是常见消化道的间叶源性肿瘤,认为其起源与胃肠道肌层的Cajal细胞有关。现在多数学者倾向于按侵袭危险性分类,即按照肿瘤的大小、核分裂的多少,将其分为极低危险性,低度危险性,中度危险性和高度危险性。影响GIST侵袭性的分子机制尚不清楚,目前肿瘤外细胞基质与肿瘤侵袭性的关系成为研究的热点之一,内皮细胞特异性分子-1( endothelial cell-specific moelecule-1, ESM-1) ,基质金属蛋白酶( matrix metalloproteinases,MMPs)及基质金属蛋白酶抑制因子tissue inhabitors of metalloproteinasrs-1,TIMPs)引起重视。ESM-1是近年发现的一种新颖的内皮细胞分泌的特异性分子,研究表明ESM-1的表达与某些肿瘤如肺癌、肾癌、结直肠癌等的发生、发展相关。ESM-1表达水平和肿瘤的侵袭性和多血管程度呈正相关。MMPs是一个蛋白水解酶大家族,可分为胶原酶、明胶酶、基质降解素以及膜型MMPs等,其中胶原酶尤为重要。越来越多的研究表明,胶原酶在肿瘤侵袭转移中起着重要的作用,而且此作用不仅仅限于它有利于细胞外基质的降解,还对肿瘤微环境的维持和促进肿瘤生长起着重要作用。TIMPs是MMPs的抑制剂,可抑制所有胶原酶的活性。ESM-1在GIST中的是否存在表达,是否与GIST肿瘤性质、生物学行为相关,及其与胶原酶及组织抑制因子的关系,国内外尚未见报道。值得进一步研究。
     目的:检测GIST中ESM-1及胶原酶与组织抑制因子的表达,分析它们与各病理参数的关系,探讨GIST组织中ESM-1的表达及其与胶原酶及组织抑制因子的关系,为预测该肿瘤的侵袭潜能提供理论依据和可能的预测指标,以指导临床的治疗和预后。
     方法:应用组织芯片平台,采用免疫组织化学技术检测69例GIST组织ESM-1、MMP-1、MMP-3和TIMP-1的表达,分析各项指标与GIST临床病理特征的关系及其相互之间的关系。
     结果:(1)免疫组化描述本组实验结果ESM-1在GIST组织中的表达呈弥漫性分布,阳性信号主要定位于细胞质。在69例GIST组织中,除1例外,其余68例均有不同程度的ESM-1表达,阳性表达率为98.5%,其中有63例为强阳性(高表达),高表达率为91.3%(63/69)。并随着GIST生物学行为恶性度的增高,其表达出现递增趋势,差异有显著性意义(P<0.05)。(2)ESM-1表达在GIST病理学形态上皮细胞型与梭形细胞型相比,统计略有增高趋势,但无统计学意义;(3) MMP-1、MMP-3和TIMP-1的表达率分别为89.9%,89.9%和84.1%,且与ESM-1的表达呈正相关。
     结论:(1)ESM-1在GIST中存在广泛高表达,与GIST的生物学行为密切相关。并对判断GIST生物学行为具有潜在意义,为预测该肿瘤的侵袭潜能提供理论依据和可能的预测指标。
     (2)胶原酶及组织抑制因子在GIST存在广泛表达,并与ESM-1共同作用于GIST的生物学行为。
Background:Gastrointestinal stromal tumor (GIST) , one of the most common sarcoma of the alimentary tract, is considered as deriving from the interstitial cells of Cajal (ICCs). Presently, many scholars tend to classify GIST into four types: extremely low risk,low risk, moderate risk and high risk, which is on the basis of its invasive chanciness according to the the size and the degree of karyokinesis of tumors. The underlying molecular mechanisms that exist in the invasive chanciness of GIST is still unclear. But more and more attention was paid to the relation between tumor extracellular matrix and tumor invasive chanciness, including endothelial-cell-specific moelecule-1 (ESM-1), matrix metalloproteinases (MMPs) , and tissue inhabitors of metalloproteinasrs-1(TIMPs). Endothelial-cell-specific molecule 1 (ESM-1) is a recently identified human endothelial cell-specific molecule. Studies have demonstrated that the expression of ESM-1 is correlated with certain tumors, such as the origin and development of lung cancer and renal carcinoma. Positive correlation has been found between the expression of ESM-1 and the degree of tumor invasiveness and its multivessel . Matrix metalloproteinases (MMPs) is a big family of proteolytic enzymes , including collagenase, gelatinase and membrane-MMPs , of which collagenase is the most important . Numerous studies have shown that collagenase plays essential roles in the invasion and metastasis of tumor , in a way that it not only contributes to the degradation of the extracellular matrix but also to the tumor microenvironment maintainence and growth of tumor. TIMPs are the inhibitors of MMPs. which could suppress the activation of all collagenases. Whether there is the expression of ESM-1 in GIST, and whether ESM-1 is related to the character and biological behavior of tumour, and whether there is close relations between collagenases and TIMP-1, are still unknown and deserve further study.
     Objective:To detect the expression level of ESM-1,MMP-1,MMP-3 and TIMP-1 in GIST, and to analyze their relation to respective clinical pathology data. To study the expression of ESM-1 and probe its relation to collagenase and tissue inhibitive factor and to find theory basis for the indicator of tumor invasion for the sake of clinical treatment and prognosis.
     Methods: Tissue microarry was used to detected the expression of ESM-1, MMP-1,MMP-3 and TIMP-1 in 69 cases of GIST by immunohistochemistry. The relation of ESM-1 expression to the clinical pathologic data, collagenase and tissue inhibitive factor was investigated .
     Results:(1)The expression of ESM-1 in the gastrointestinal stromal tumor is diffusely distributed and ESM-1 is mainly positive in the cytoplasm. ESM-1 is expressed in 68 cases of the 69 cases and the expression rate reaches to 98.5% (68/69). Of the 68 cases 63 cases are strong positive with a high expression rate of 91.3% ( 63/69). Along with increased degree of malignant GIST , the expression of ESM-1 increases with statistical significance (P<0.05). (2)In the form of pathological morphology , compared with the expression level of ESM-1 in spindle cells there is a trend that ESM-1 expression level in epithelial cells increases but with no statistical significance. ( 3 ) The expression rate of MMP-1,MMP-3 and TIMP-1 in the gastrointestinal stromal tumor reaches to 89.9%, 89.9% and 84.1% respectively. And they are positively correlated with ESM-1 expression. Conclusions:(1)ESM-1 is widely expressed in the gastrointestinal stromal tumor (GIST) with a high rate , and is closely related with the biological behavior of GIST , which might be a potential indicator of biological behaviour of GIST. (2)There is also a wide expression of collagenase and tissue inhibitive factor in GIST and they are both relate to the biological behavior of GIST as ESM-1 .
引文
1. MazurMT, Clark HB. Gastric stromal tumors: reappraisal of histogenesis[J] .AM J Surq Pathol,1983;7 (6) : 507-519.
    2. Fletcher CD,Berman JJ,Corless C,et al. Diagnosis of gastrointestinal stromal tumors:a consensus approach[J] . Pathol,2002;33(5):459-465.
    3.杨其昌,季小华,沈屹,等.74例胃肠道间质瘤临床病理与生物学行为评价[J].中华病理学杂志.2005,34(1):6-10.
    4. Miettinen M, Majidi M, Lasota J. Pathology and diagnostic criteria of gastrointestinal stromal tumors(GISTs) [J] .a review Fur J Cancer,2002;38(Suppl 5): S39-S51.
    5. Parfitt JR,Rodriguez-Justo M, Feakins R,et al.astrointestinal Kaposi's sarcoma:CD117 expression and the potential for misdiagnosis as gastrointestinal stromal tumour Histopathology[J].Histopathology,2008;52(7):816-823.
    6. Hoashi T,Kadono Tikuchi K,et al, Biochem Biophys Rescommun Differential growth regulation in human melanoma cell lines by TIMP-1 and TIMP-2[J].Biochem Biophys Res Commun,2001;288(2):371-379.
    7. Akao M, Hasebe Y, Okumura N,et al. Plasminogen activator-plasmin system potentiates the proliferation of hepatocytes in primary culture[J] .Thromb Res,2002; 107(3-4):169-174.
    8. Elkin M, Ariel I, Miao HQ,et al.Inhition of Blaadder Carcinoma Angtogenesis,stromal support,and tumor Growth by Halofugione[J].Cancer Res,1999;59:4111-4118.
    9. Lassalle P, Molet S, Janin A, et al. ESM-1 is a Novel Human Endothelial Cellspecific Molecule Expressed in Lung and Regulated by Cytokines[J].J Biol Chem,1996; 271(34): 20458-20464.
    10. Sarrazin S, Adam E, Lyon M,et al .Endocan or endothelial cell specific molecule-1 (ESM-1): a potential novel endothelial cell marker and a new target for cancer therapy[J].Biochim Biophys Acta,2006 ;1765(1):25-37.
    11. Zuo L,Zhang SM,HU RL,et al.Correlation between expression and differentiation of endocan in colorectal cancer[J].World J Gastroenterol,2008;14(28): 4562-4568.
    12. Tsai JC,Zhang J,Minami T,et al.Cloning and characterization of the human lung endothelial-cell-specific molecule promoter[J].J Vasc Res,2002;39(2):148-159.
    13. Rennel E,Mellberg S,et al.Endocan is a VEGF-A and P13K regulated gene with increased expression in human renal cancer.Exp Cell Res.2007;313(7):1285-1294.
    14. Scherpereel A,Gentina T,Griqoriu B,et al.Overexpression of endocan induces tumor formation.CancerRes[J].Cacer Res,2003;63(18):6084-6089.
    15.倪婧,吴强,吴正升,等.恶性淋巴瘤组织中内皮细胞特异性分子-1mRNA及其蛋白的表达[J].安徽医科大学学报,2005(40):5.
    16. Grigoriu BG, Depontieu F, Scherpereel A, et al. Endocan expression and relationship with survival in human non small cell lung cancer[J]. Clin Cancer Res, 2006; 12 (15): 4575-4582.
    17. Sarrazin S,Adam E,Lyon M,et al.Endocan or endothelial cell specific molecule-1 (ESM-1): a potential novel endothelial cell marker and a new target for cancer therapy[J].Biochim Biophys Acta,2006;1765(1):25-37.
    18. Shin JW, Huggenberger R, Detmar M.Transcriptional profiling of VEGF-A and VEGF-C target genes in lymphatic endothelium reveals endothelial-specific molecule-1 as a novel mediator of lymphangiogenesis[J]. Blood,2008; 112(6): 2318- 2326.
    19. Wellner M,Herse F,Janke J,et al.Endothlial cell specisic molecule-1-A newly identified protein in adipocytes[J].Horm Metab Res,2003;35(4):217-221.
    20.熊江霞,张素梅,王雪,等.抗人内皮细胞特异性分子单克隆抗体的研制和初步鉴定[J].现代免疫学,2004,24(3):217-20.
    21. Kononen J ,Bubendorf L,Kallionieni A,et al. Tissue microarrays for high throughput molecular profiling of tumor specimens[J].Nat Med,1998;4 (7) :844-847.
    22.吴正升,吴强,周隽,等. PTEN蛋白表达和明胶酶及其抑制因子在乳腺癌侵袭转移中的关系[J].中国组织化学与细胞化学杂志,2004 ,13 (2) :193-198.
    23. Bhaskar V, Shridevi K, Aptullah H, et al. Increased expression of matrixmetalloproteinases 2 and 9 and tissue inhibitor of metallopro-teinases 1 and correlate with poorprognostic variables in renal cell carcinoma[J].Clin Can Res ,2001;7 :3113-3119.
    24. Bachard D,Meignin V,Scherpereel A,et al.Characterzation of the secreted from of endothelial-cell-specific molecule 1 by specific monoclonal antibodies[J].J Vasc Res,2000;37(5):417-425.
    25. Augustin HG.Antiangiogein tumor therapy:will it work?.T[J].rends Pharmacol Sci,1998;19(6):1887-1900.
    26.熊江霞,吴正升,吴强,等.内皮细胞特异性分子-1在肾癌组织的表达[J].中国肿瘤, 2004,13(5):309-312.
    27. van 't Veer LJ, Dai H, van de Vijver MJ, et al.Gene expression profiling predicts clinical outcome of brest cancer[J].Nature ,2002;415(6871):530-536.
    28. Amatschek S,Koenig U,Auer H,et al.Tissue-wide expression profiling using cDNA subtraction and microarrays to identify tumor-specfic genes[J].Cancer Res,2004;64: 844-856.
    29. Yancopoulos G D, Davis S, Gale NW,et al.vascular-specific growth factors and blood Bessel formation[J]. Nature,2000;volume 407:242-248.
    30. Pour L, Hájek R, Buchler T, et al. Angiogenesis and antiangiogenic cancer therapy[J]. Vnitr Lek,2004;50(12):930-938.
    31. Aitkenhead M,Wang SJ,Nakatsu MN,et al.Identification of endothelial cell genes expressed in an vitro model of angiogenesis:induction of ESM-1.9 (beta) ig-h3,and NrCAM[J].Microcase Res,2002;63(2):159-171.
    32. Kahn J, Mehraban F, Ingle G,et al.Gene expression profiling in an in vitro model ofangiogenesis[J].Am J Pathol,2000;156(6): 1887-1900.
    33.回允中主译.阿克曼外科病理学.第8版:645-647.
    34. Orosz Z, Tornoczky T, Sapi Z, et al.Gastrointestinal stromal tumors : a clinicopathologic immunohistochemical study of 136 cases[J]. Pathol Oncol Res,2005; 11 (1) :11-21.
    35. Fletcher CD,Beman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: A consensus app roach[J]. Hum Pathol,2002;33 (5) : 459-465.
    36. Parfitt JR, Rodriguez-Justo M, Feakins R, et al. Gastrointestinal Kaposi's sarcoma:CD117 expression and the potential for misdiagnosis as gastrointestinal stromal tumour Histopathology[J]. 2008; 52(7): 816-823.
    37. MiettinenM, Lasota J.Gastrointestinal stromal tumors definition clinical histilogical immunohistochemical and molecular genetic features and differential diagnosis[J]. Virehows Arch,2001;438(1) : 1-12.
    38. Sarlomo-Rikala M, Kovatich AJ, Barusevicius A, et al. CD117: a sensitive marker for gastrointestinal stromal tumors that is more specific than CD34[J]. Mod Pathol,1998; 11:728-734.
    39. Hirvonen R,Talvensari-Mattila A,Pakko P,et al. Matrix metallo-proteinase-2(MMP-2)in T(1-2)N0 breast carcinoma[J].Breast Cancer Res Treast,2003; 7791:85-89.
    40. Wu ZS, Wu Q, Yang JH,et al. Prognostic significance of MMP-9 and TIMP-1 serum and tissue expression in breast cancer[J].Int. J. Cancer,2008;122(2):2050–2056.
    41.李杰茹,齐风英.基质金属蛋白酶抑制剂与肿瘤侵袭转移[J].国外医学:肿瘤学分册,2004,31(6):409.
    42.朱宝和,詹文华,刘弋,等. PTEN与基质金属蛋白酶在胃癌组织中的表达及意义[J].中国现代普通外科进展,2006,9(1):33-36.
    43. Kleiner D,Stetler-StevensonW.Matrix metallproteinases and metastasis[J].Cancer Chemother Phamcol,1999;43(suppl):42.
    44. La Rocoa G, Pacci-Minafra I, Marrazzo A, et a1. Zymogrophic detection and clinical correlations of MMP- 2 and MMP- 9 in breast cancer sera[J]. Br J Cancer, 2004; 90( 7) :1414-1421.
    45. Ishiguro N,Ito T,Oguchi T,et al.Relationships of matrix metalloproteinases and their inhibitors to cartilage proteoglycan and collagen turnover and inflammation as revealed by analyses of synovial fluids from patients with rheumatoid arthritis[J]. Arthritis Rheum,2001;44(11):2503-2511.
    46. Kurizaki T,Toi M,Tominaga T.Relationship between matrix metalloproteinase exprwession and tumor angiogenesis in human breast carcinoma[J].Oncol Rep,1998; 5(3):673-677.
    47. Shiozawa J , Ito M, Nakayama T, et al .Expression of matrix metalloproteinase-1 inhuman colorectal carcinoma[J]. Mod Pathol ,2000;13 (9) :925 - 933.
    48. Zuker S,Vacirca J.Role of matrix metallproteinases(MMPs) in colorectal cancer[J]. Cancer Metasis Rev ;2004,23(1-2):101-117
    49. Li YH,Shao JY,Li S,et al.Clinical significance of quantitative analysis of serumVEGF,CD44 and MMP-3 protein in nasopharyngeal carcinaoma[J]. Cancer, 2004;23(9):1060-1064.
    50.刘勇,刘季春.食管鳞癌组织中MMP-1和TIMP-1的表达及临床意义[J].江西医学院学报,2008,48(4):82-84.
    1. MazurMT, Clark HB. Gastric stromal tumors: reapp raisal of histogenesis[J]. Am J Surg Pathol, 1983;7 (6) : 507-519.
    2. Bubin BP.Gastrointestinal stromal tumors: An update[J].Histopathology, 2006;48(1): 83- 96.
    3. Kamiyama Y,Aihara R,Nakabayashi T,et al.18F-Fluorodeox-glucose position emission tomography:useful technique for predicting malignant potential of gastrointestinal stromal tumors[J].World J Surg,2005;29(11):1429-1495.
    4. Lux ML, Rubin BP, Biase TL, et al. KIT extracellular and kinase domain mutations in gastrointestinal stromal tumors[J]. Am J Pathol .2000;156:791–795.
    5. Taniguchi M, Nishida T, Hirota S, et al. Effect of c-kit mutation on prognosis of gastrointestinal stromal tumors[J].Cancer Res.1999;59:4297–4300.
    6. Heinrich MC, Corless CL, Duensing A, et al. PDGFαactivating mutations in gastrointestinal stromal tumors[J]. Science, 2003;299 (5607) : 708-710.
    7. Terada T.Gastrointestinal stromal tumor of the uterus: a case report with genetic analyses of c-kit and PDGFRA genes[J].Int J Gynecol Pathol. 2009 ;28(1):29-34.
    8.罗容珍,梁小曼,何洁华,等.154例胃肠道间质瘤的临床病理及免疫组化特征[J].广东医学,2004;25( 3) : 244-6.
    9. Miettinen M, Lasota J. Gastrointestinal stromal tumors definition clinical histilogical immunohistochemical and molecular genetic features and differential diagnosis[J]. Virehows Arch, 2001;438(1) : 1212.
    10. Miettinen M, Virolainen M, Maarit-Sarlomo-Rikala. Gastrointestinal stromal tumors -- value of CD34 antigen in their identification and separation from true leiomyomas and schwannomas[J]. Am J Surg Pathol.1995;19:207-216.
    11. Sarlomo-Rikala M, Kovatich AJ, Barusevicius A, et al. CD117: a sensitive marker for gastrointestinal stromal tumors that is more specific than CD34[J]. Mod Pathol. 1998;11:728-734.
    12. Nilsson B,Bumming P,Meis-Kindblom JM, et al. Gastrointestinal stromal tumors: The incidence,prevalence,clinical course,and prognostication in the preimatinib mesylate era--a population-based study in Westen Sweden[J]. Cancer, 2005;103 (4) : 821-829.
    13. Bucher P, Egger JF, Gervaz P, et al. An audit of surgicalmanagement of gastrointestinal stromal tumours (GIST) [J].Eur J Surg Oncol, 2006;32(3) : 310-314.
    14. Fletcher CD,Beman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: A consensus app roach[J]. Hum Pathol,2002;33 (5) : 459-465.
    15. Hirota S, Isozaki K, Moriyama Y, et al. Gain of function mutations of c- kit in human gastrointestinal stromal tumors[J]. Science. 1998; 279(5350): 577-580
    16. Hasegawa T,Matsuno Y,Shimoda T,et al.Gastrointestinal stromal tumor:consisitent CD117 immunostaining for diagnosis,and prognostic classification based on tumor size and MIB-1 grade[J].Hum Pathol,2002;33:669-76.
    17.孙巍,郭启勇,王玉,等.多层螺旋CT对胃肠道间质瘤的诊断价值.中国医学影像技术[J],2004;20(10):1529-31.
    18. Fusaroli P, Caletti G. Endoscopic ultrasonography: current clinical role[J].Eur J Gastroenterol Hepatol,2005;17(3):293- 301.
    19.周东风,李宏,林惠忠,等.原发性小肠肿瘤36例临床分析[J].中国现代普通外科进展, 2004; 7( 3) : 184-185.
    20. Avritscher R, Gupta S.Gastrointestinal stromal tumor: role of interventional radiology in diagnosis and treatment[J].Hematol Oncol Clin North Am. 2009 ;23(1):129-137.
    21. Everett M, Gutman H.Surgical management of gastrointestinal stromal tumors: analysis of outcome with respect to surgical margins and technique[J].J Surg Oncol. 2008;98(8):588-593.
    22. Winfield RD, Hochwald SN,Vogel SB, et al. Presentation and management of gastrointestinal stromal tumors of the duodenum[J].Am Surg, 2006;72 (8) : 719-723.
    23.师英强,杜春燕.胃肠道间质瘤的外科治疗问题[J].肿瘤研究与临床,2006;18(8): 518-520.
    24. Fernandes Gdos S, Blanke CD, Freitas D, et al. Perioperative treatment of gastrointestinal stromal tumors[J].Oncology (Williston Park). 2009;23(1):54-61.
    25. Blay JY, Bonvalot S, Casali P, et al. Consensus meeting for the management of gastrointestinal stromal tumors. Report of the GIST Consensus Conference of 20-21 March 2004. under the auspices of ESMO[J].Ann Oncot,2005,16(4): 566-578.
    26. Tabrizian P, Nguyen SQ, Divino CM.Laparoscopic management and longterm outcomes of gastrointestinal stromal tumors[J].J Am Coll Surg. 2009 ;208(1):80-86.
    27. Dell'avanzato R, Carboni F, Palmieri MB, et al. Laparoscopic resection of sporadic synchronous gastric and jejunal gastrointestinal stromal tumors: Report of a case[J].Surg Today. 2009;39(4):335-339.
    28.郑民华,马君俊.腹腔镜手术治疗胃肠道间质瘤[J].中国实用外科杂志, 2006;26 (8) : 586.
    29. Hindmarsh A, Koo B, Lewis MP,et al. Laparoscopic resection of gastric gastrointestinal stromal tumors[J]. Surg Endosc,,2005; 19(8) : 1109-1112.
    30. Matthews BD,Walsh RM, Kercher KW, et al. Laparoscopic vs open resection of gastric stromal tumors[J]. Sung Endosc, 2002;16: 803-807.
    31. Joensuu H, Roberts PJ, Sarlomo-Rikala M, et al.Effect of the tyrosine kinase inhibitor STI571 in a patient with metastatic gastrointestinal stromal tumor[J]. N Engl J Med,2001;344 (14):1052- 1056.
    32. Ryu MH, Kang WK, Bang YJ,et al. A Prospective, Multicenter, Phase 2 Study of Imatinib Mesylate in Korean Patients with Metastatic or Unresectable Gastrointestinal Stromal Tumor[J].Oncology. 2009 ;76(5):326-332.
    33. Savage DG, Antman KH. Imatinib mesylate- a new oral target therapy[J]. N Engl J Med, 2002;346(9):683- 693.
    34. Blanke CD, Rankin C, Demetri GD, et al. PhaseⅢrandomized,intergroup trial assessing imatinib mesylate attwo dose levels in patients with unresectable or metastatic gastrointestinal stromal tumors expressing the kit receptor tyrosine kinase: S0033[J].J Clin Oncol,2008;26(4):626-632.
    35. Verweij J,Casali PG,Kotasek D,et al.Imatinib does not induce cardiac left ventricular failure in gastrointestinal stromal tumors patients: analysis of EORTC-ISG-AGITG study 62005[J]. Eur J Cancer, 2007;43(6):974-8.
    36. Cohen MH, Farrell A, Justice R, et al. Approval summary: imatinib mesylate in the treatment of metastatic and/or unresectable malignant gastrointestinal stromal tumors[J].Oncologist. 2009 ;14(2):174-180.
    37. Fiore M, Palassini E, Fumagalli E, et al. Preoperative imatinib mesylate for unresectable or locally advanced primary gastrointestinal stromal tumors (GIST) [J].Eur J Surg Oncol. 2008 ; 23.
    38. Holdsworth CH,Badawi RD, Manola JB, et al. CT and PET: early prognostic indicators of Response to imatinib mesylate in patientswith gastrointestinal stromal tumors AJR[J].Am Roentgenol, 2007;189 (6) :324-330.
    39. Song Z, Yue-Long P, De-You T,et al.Secondary C-kit mutation is a cause of acquired resistance to imatinib in gastrointestinal stromal tumor[J].Scand J Gastroenterol. 2008; 18:1-4.
    40. Paz-Ares L, García del Muro X, et al.Cost-effectiveness analysis of sunitinib in patients with metastatic and/or unresectable gastrointestinal stroma tumours (GIST) after progression or intolerance with imatinib[J].Clin Transl Oncol. 2008;10(12): 831-839.

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